cancer facts....cancer dying from the disease within five years of diagnosis cancer deaths: rate of...

1

Cancer Facts.

WHAT ARE THE MAIN GEOGRAPHIC DIFFERENCES IN CANCER ACROSS QUEENSLAND?

Terms used in this report:

Incidence (diagnosis): number of new cancers diagnosed in Queensland between 2012 and 2016.

Standardised incidence ratio (SIR): compares the cancer diagnosis rate between a region and the Queensland

average. Values higher than one indicate higher incidence, values lower than one indicate lower incidence.

Excess death rate: is a survival-based measure, but refers to the deaths caused by a cancer diagnosis within five

years of diagnosis.

Excess hazard ratio (EHR): compares the excess death rate between a geographical region and the Queensland

average. An EHR lower than one implies lower excess mortality rates, which is the same as higher survival.

Mortality (deaths): number of cancer deaths in Queensland during 2012 and 2016.

Standardised mortality ratio (SMR): compares the cancer mortality rate between a region and the Queensland

average. Values higher than one indicate higher mortality, values lower than one indicate lower mortality.

Terms used to describe geographical areas (see page 12 for more details)

Remoteness: This is a measure that reflects general services in a specific area, and proximity to other services.

Categories are: Major cities (urban), Inner regional, Outer regional, Remote and Very remote combined.

Area disadvantage: This is a measure that reflects the level of socioeconomic disadvantage of a specific area,

according to the median socioeconomic characteristics of people living in that area. Categories are: Least

disadvantaged, Less disadvantaged, Middle, More disadvantaged, Most disadvantaged.

Accessibility: This is a measure that reflects the driving time from a specific area to the nearest Queensland public

and private radiotherapy facility in 2011. Categories are: <1 hour (reference), 1-<2 hours, 2-<4 hours, 4-<6 hours, 6+

hours

How to interpret the numbers

A ratio of 1.0 indicates no difference to the Queensland average, while a ratio above 1.0 indicates an increase in

incidence (SIR), excess death rate (EHR) and mortality (SMR), compared to the Queensland average. Note that a

higher excess death rate (HER) is equivalent to a lower relative survival.

For example:

➢ An SIR of 0.88 for all cancers among people who live in remote/very remote areas compared to those who live in

major cities (see page 6 table) indicates that people living in remote/very remote areas have an 12 per cent lower

rate of cancer diagnosis compared to those who live in major cities. The 95 per cent confidence interval for this

SIR is 0.84-0.93. Since this does not include 1, this is considered to be significantly lower.

➢ An EHR of 1.18 for lung cancer among people who live 6+ hours away from the closest radiotherapy facility

compared to those who live <1 hour away (see page 11 table) indicates that people who live 6+ hours away have

a 18% higher excess death rate (or lower survival) due to lung cancer compared to those who live <1 hour away.

➢ An SMR of 1.32 for melanoma among people living in the most disadvantaged areas compared to the least

disadvantaged areas (see page 8 table) indicates that people living in the most disadvantaged areas have a 32%

higher mortality rate due to melanoma compared to those who live in the least disadvantaged areas.

Where you live can influence your risk of being diagnosed with cancer, surviving cancer, or dying from cancer. This fact sheet reports the latest available Queensland cancer data by where people live according to remoteness, area disadvantage and accessibility to radiation treatment facilities. This information covers the years 2012-2016, unless otherwise stated.

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Is there variation in cancer incidence, survival and mortality by ‘Remoteness’ between 2012 and 2016?

(All estimates are compared to Major City areas)

Cancer diagnosis: Rate of new cancers diagnosed

Cancer survival: Corresponds to the risk of people diagnosed with cancer dying from the disease within five years of diagnosis

Cancer deaths: Rate of deaths due to cancer

The following summary is based on the data tables on pages 6-11 (Note that Cancer survival is the inverse of Excess deaths).

Cancer diagnoses? Cancer survival? Cancer deaths?

All cancers Yes

Higher in regional areas, Lower in remote areas

Yes

Lower in regional and remote areas

Yes

Higher in regional areas

Prostate cancer Yes

Higher in regional areas, Lower in Remote areas

Yes

No clear pattern

No

Melanoma Yes

Lower in outer regional and remote areas.

No Yes

Higher in regional areas, Lower in remote areas

Breast cancer Yes


No No

Bowel cancer Yes

Higher in inner regional areas

No Yes

Higher in inner regional areas

Lung cancer Yes

Higher in outer regional and remote areas

Yes


Yes

Higher in regional and remote areas

Major cities

3

Is there variation in cancer incidence,

survival and mortality by area-level ‘Area

disadvantage’ between 2012 and 2016?

[All estimates are compared to the areas of least disadvantaged (or most affluent areas)]




The following summary is based on the data tables on pages 6-11 (Note that cancer survival is the inverse of excess deaths).


All cancers Yes

Higher in areas of greater disadvantage

Yes

Lower in areas of greater disadvantage

Yes


Prostate cancer Yes


Yes


Yes


Melanoma Yes


Yes


Yes


Breast cancer Yes


Yes


No

Bowel cancer Yes

Higher in areas of greater/greatest disadvantage

Yes


Yes


Lung cancer Yes


Yes


Yes


4

Is there variation in cancer incidence, survival and mortality by ‘Accessibility’ between 2012 and 2016?

Accessibility is measured by the driving time to the closest radiation facility. All estimates are compared to <1 hour travelling time.


All cancers Yes

Lower in less accessible areas

Yes


Yes

Higher in less accessible areas

Prostate cancer Yes

No consistent pattern

No

No

Melanoma Yes


No

No

Breast cancer Yes


No

No

Bowel cancer Yes

Higher in moderately less accessible areas (1-<4 hours

travelling)

No

Yes

Higher in moderately less accessible areas (2-<4 hours

travelling)

Lung cancer Yes


Yes


Yes





The following summary is based on the data tables on pages 6-11 (Note that Cancer survival is the inverse of Excess deaths).

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Notes: Red markings represent different rural groupings (remoteness) and is in comparison to major city areas (reference). Blue markings represent area disadvantage quintiles and is in comparison to least disadvantaged areas (reference). Black markings represent accessibility (driving distance to radiotherapy facilities) and is in comparison to <1 hours driving time (reference).

All Cancer Prostate Cancer Melanoma Breast Cancer Bowel Cancer Lung Cancer

Inc

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5-y

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Mo

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Overview of differences in cancer incidence, 5-year excess deaths and mortality by Remoteness, Area disadvantage

and accessibility, 2012-2016

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Differences by type of cancer (2012-2016)

All cancers

Incidence Excess deaths Mortality

Count Rate SIR [95% CI] 5-year (%) EHR [95% CI] Count Rate SMR [95% CI]

Total Queensland 27,518 538.1 30.0 8,910 173.1

By remoteness Overall significance1, p<0.001 Overall significance1, p<0.001 Overall significance1, p<0.001

Major city 16,380 529.3 1 28.7 1 4,983 159.4 1

Inner regional 6,448 545.2 1.02 [1.01, 1.03]* 30.6 1.11 [1.08, 1.14] * 2,068 170.0 1.06 [1.03, 1.08] *

Outer regional 3,997 551.1 1.03 [1.01, 1.04]* 30.8 1.20 [1.16, 1.24] * 1,225 173.5 1.08 [1.05, 1.11] *

Remote/Very remote 563 488.8 0.88 [0.84, 0.93] * 34.4 1.29 [1.20, 1.38] * 185 174.8 0.99 [0.90, 1.07]

By area disadvantage

Overall significance1, p<0.001 Overall significance1, p<0.001 Overall significance1, p<0.001

Least disadvantaged 4,584 524.2 1 23.3 1 1,188 143.6 1

Less disadvantaged 5,378 518.4 0.99 [0.97, 1.01] 27.2 1.08 [1.04, 1.13] * 1,532 153.0 1.07 [1.03, 1.11] *

Middle 20% 5,753 529.7 1.01 [1.00, 1.03] 29.2 1.16 [1.12, 1.21] * 1,783 160.4 1.13 [1.09, 1.16] *

More disadvantaged 5,862 546.0 1.04 [1.02, 1.06] * 32.2 1.27 [1.22, 1.32] * 1,935 174.6 1.22 [1.18, 1.26] *

Most disadvantaged 5,810 557.8 1.07 [1.05, 1.08] * 34.5 1.32 [1.27, 1.37] * 2,020 186.6 1.30 [1.26, 1.34] *

By accessibility Overall significance1, p=0.0013 Overall significance1, p<0.001 Overall significance1, p<0.001

<1 hour 21,420 533.7 1 28.8 1 6,519 161.3 1

1-<2 hours 1,609 545.4 1.01 [0.99, 1.03] 32.2 1.15 [1.10, 1.20] * 535 175.5 1.07 [1.03, 1.11] *

2-<4 hours 2,168 555.4 1.03 [1.01, 1.05]* 34.5 1.12 [1.07, 1.16] * 727 179.3 1.09 [1.05, 1.13] *

4-<6 hours 1,657 528.0 0.98 [0.96, 1.01] 31.5 1.14 [1.09, 1.19] * 513 168.8 1.04 [1.00, 1.08]*

6+ hours 534 516.3 0.95 [0.91, 0.98] * 34.2 1.26 [1.17, 1.35] * 169 184.3 1.10 [1.03, 1.18] *

Notes:

SIR=Standardised Incidence Ratio, EHR=Excess Hazard Ratio, SMR=Standardised Mortality Ratio

Rates expressed per 100,000 and are age-standardised to the 2001 Australian standard population

Count reported as average number of cases/deaths observed per year aggregated over 2012-2016 period.

Counts do not sum to the Queensland total as some cases could not be assigned to an area.

5-year excess death rate calculated as = 100% - 5-year relative survival calculated using the period method for ‘at-risk’ cases during 2012-2016 for ages 0-89 years. SIR and SMR are obtained using Poisson models adjusted for broad age groups and sex.

EHR are additionally adjusted for broad types of cancer.

High EHR equates to low survival

Models are run separately for remoteness, area disadvantage and accessibility

1. Overall significance of geographical variable assessed using the likelihood ratio test

2. * Statistical differences (p<0.05) for the specific geographical category compared to the reference category.

Only relevant when there is a significant overall effect for that variable.

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Differences by type of cancer (2012-2016) (cont.)

Prostate cancer



Total Queensland 4,046 75.9

6.1

650 29.0

By remoteness Overall significance1, p=0.04 Overall significance1, p=0.024 Overall significance1, p=0.717

Major city 2,302 72.3 1 5.8 1 353 26.3 1

Inner regional 1,012 79.5 1.05 [1.02, 1.09] * 4.5 0.74 [0.55, 1.00] 147 26.8 1.02 [0.93, 1.11]

Outer regional 619 81.7 1.04 [1.00, 1.08]* 7.2 1.19 [0.90, 1.56] 87 27.5 1.06 [0.96, 1.18]

Remote/Very remote 85 72.2 0.83 [0.74, 0.95]* 9.5 1.52 [0.90, 2.58] 14 32.2 1.01 [0.74, 1.39]

By area disadvantage Overall significance1, p<0.001 Overall significance1, p=0.019 Overall significance1, p=0.039

Least disadvantaged 738 83.3 1 5.2 1 86 25.6 1

Less disadvantaged 786 74.1 0.89 [0.85, 0.93] * 7.3 1.73 [1.18, 2.52]* 103 24.1 0.97 [0.85, 1.10]

Middle 20% 848 74.3 0.90 [0.86, 0.94] * 5.6 1.29 [0.87, 1.93] 132 26.8 1.06 [0.94, 1.20]

More disadvantaged 849 74.6 0.89 [0.85, 0.93] * 6.8 1.63 [1.12, 2.38]* 144 28.8 1.14 [1.02, 1.29] *

Most disadvantaged 797 71.5 0.86 [0.82, 0.90] * 3.9 1.25 [0.83, 1.89] 136 27.5 1.08 [0.96, 1.22]

By accessibility Overall significance1, p=0.017 Overall significance1, p=0.396 Overall significance1=0.201

<1 hour 3,081 74.1 1 5.7 1 460 26.4 1

1-<2 hours 254 77.5 0.99 [0.94, 1.05] 5.1 0.82 [0.49, 1.37] 42 29.5 1.13 [0.98, 1.30]

2-<4 hours 335 78.0 1.00 [0.95, 1.06] 5.7 1.00 [0.68, 1.47] 55 28.9 1.09 [0.96, 1.23]

4-<6 hours 270 83.9 1.07 [1.01, 1.13] * 6.0 1.07 [0.71, 1.62] 32 24.1 0.93 [0.79, 1.09]

6+ hours 79 74.9 0.88 [0.80, 0.98] * 8.0 1.64 [0.96, 2.81] 12 32.5 1.13 [0.87, 1.47]

Notes:










2. * Statistical differences (p<0.05) for the specific geographical category compared to the reference category. Only relevant when there is a significant overall effect for that variable.

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Melanoma




7.2

364 7.18

By remoteness Overall significance1, p=0.0002 Overall significance1, p=0.073 Overall significance1, p<0.001

Major city 2,280 74.5 1

6.3 1

193 6.21 1

Inner regional 862 76.8 1.01 [0.98, 1.05] 7.7 1.19 [0.96, 1.46] 94 7.98 1.25 [1.12, 1.40] *

Outer regional 520 72.4 0.96 [0.92, 1.00]* 8.1 1.28 [1.00, 1.63] 54 7.86 1.21 [1.05, 1.38] *

Remote/Very remote 63 54.6 0.77 [0.67, 0.88]* 1.4 0.37 [0.08, 1.71] 4 3.63 0.50 [0.27, 0.90] *


Overall significance1, p=0.0001 Overall significance1, p=0.002 Overall significance1, p=0.015

Least disadvantaged 687 77.0 1

8.2 1

48 5.75 1

Less disadvantaged 758 72.7 0.94 [0.90, 0.99] * 8.3 1.47 [1.07, 2.01] 67 6.65 1.16 [0.99, 1.37]

Middle 20% 816 72.7 1.01 [0.95, 1.04] 7.3 1.46 [1.07, 2.01] * 73 6.77 1.18 [1.00, 1.39] *

More disadvantaged 764 74.1 0.95 [0.91, 0.99] * 6.6 1.74 [1.28, 2.37]* 77 7.18 1.25 [1.07, 1.47] *

Most disadvantaged 700 70.0 0.91 [0.87, 0.95] * 3.9 1.85 [1.35, 2.53] * 79 7.60 1.32 [1.12, 1.55] *

By accessibility Overall significance1, p<0.001 Overall significance1, p=0.059 Overall significance1, p=0.060

<1 hour 2,978 75.2 1

6.5 1

262 6.55 1

1-<2 hours 215 78.2 1.01 [0.95, 1.08] 7.1 1.28 [0.90, 1.83] 21 7.19 1.08 [0.89, 1.32]

2-<4 hours 283 77.4 1.01 [0.95, 1.06] 8.7 1.46 [1.09, 1.94] * 33 8.71 1.27 [1.08, 1.49] *

4-<6 hours 190 60.2 0.79 [0.74, 0.85] * 8.6 1.31 [0.92, 1.87] 22 7.01 1.07 [0.88, 1.30]

6+ hours 60 57.6 0.73 [0.65, 0.82] * 5.7 1.03 [0.49, 2.17] 6 6.82 0.94 [0.66, 1.34]

Notes:











9


Breast cancer (females only)




9.6

557 20.5

By remoteness Overall significance1, p<0.001 Overall significance1, p =0.340 Overall significance1, p =0.541

Major city 2,090 130.8 1

8.8 1

320 19.0 1

Inner regional 719 122.7 0.94 [0.91, 0.98] * 8.4 0.96 [0.79, 1.15] 123 19.5 1.04 [0.95, 1.14]

Outer regional 454 125.6 0.96 [0.92, 1.01] 9.1 1.02 [0.82, 1.27] 71 19.6 1.02 [0.91, 1.15]

Remote/Very remote 51 92.0 0.68 [0.58, 0.80] * 12.2 1.46 [0.94, 2.27] 9 17.5 0.80 [0.54, 1.19]

By area disadvantage Overall significance1, p=0.0003 Overall significance1, p =0.003 Overall significance1, p =0.818


10.8 1

85 18.2 1

Less disadvantaged 678 124.4 0.91 [0.87, 0.96] * 9.1

1.09 [0.84, 1.40] 104 18.9 1.04 [0.91, 1.18]

Middle 20% 707 129.4 0.94 [0.90, 0.99] * 9.2

1.39 [1.09, 1.76] * 113 19.5 1.05 [0.93, 1.20]

More disadvantaged 663 125.2 0.92 [0.87, 0.96] * 8.2

1.36 [1.07, 1.74] * 113 20.2 1.08 [0.95, 1.23]

Most disadvantaged 626 121.9 0.90 [0.86, 0.95] * 6.9

1.51 [1.18, 1.93] * 106 19.2 1.05 [0.93, 1.20]

By accessibility Overall significance1, p=0.004 Overall significance1, p =0.600 Overall significance1, p=0.669

<1 hour 2,666 129.1 1

8.7 1

419 19.4 1

1-<2 hours 174 123.9 0.96 [0.89, 1.02] 8.7 0.84 [0.57, 1.23] 26 17.8 0.90 [0.75, 1.07]

2-<4 hours 233 123.9 0.97 [0.91, 1.03] 9.7 1.09 [0.82, 1.44] 38 19.1 0.99 [0.85, 1.14]

4-<6 hours 185 118.7 0.92 [0.86, 0.98] * 9.1 1.11 [0.82, 1.49] 29 18.0 0.93 [0.79, 1.10]

6+ hours 56 110.0 0.85 [0.75, 0.95]* 10.9 1.30 [0.81, 2.09] 10 22.2 1.08 [0.81, 1.43]

Notes:











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Bowel cancer


Count Rate SIR [95% CI] 5-year (%)

EHR [95% CI] Count Rate SMR [95% CI]


30.9

1,063 20.7

By remoteness Overall significance1, p=0.035 Overall significance1, p=0.328 Overall significance1, p=0.015

Major city 1,833 59.4 1

29.9 1

593 19.0 1

Inner regional 762 64.1 1.07 [1.03, 1.11] * 31.6 1.07 [0.98, 1.16] 256 21.2 1.11 [1.04, 1.19] *

Outer regional 444 62.8 1.04 [0.99, 1.09] 30.2 1.04 [0.94, 1.15] 141 20.5 1.06 [0.98, 1.15]

Remote/Very remote 66 58.8 0.94 [0.81, 1.08] 29.6 1.14 [0.90, 1.44] 19 20.6 0.97 [0.75, 1.24]


Overall significance1, p<0.001 Overall significance1, p=0.001 Overall significance1, p<0.001


33.9 1

148 18.0 1

Less disadvantaged 605 59.6 1.05 [1.00, 1.11] 31.4

1.07 [0.95, 1.21] 180 18.0 1.01 [0.92, 1.12]

Middle 20% 653 59.9 1.05 [1.00, 1.11]* 29.3

1.10 [0.97, 1.24] 207 18.6 1.04 [0.95, 1.15]


1.17 [1.04, 1.31] * 230 20.8 1.16 [1.06, 1.27] *


1.27 [1.13, 1.43]* 245 22.7 1.26 [1.15, 1.38] *

By accessibility Overall significance1, p=0.007 Overall significance1, p=0.108 Overall significance1, p=0.003

<1 hour 2,393 59.9 1

30.0 1

771 19.1 1

1-<2 hours 193 64.3 1.07 [1.00, 1.14]* 29.8 0.98 [0.85, 1.14] 63 21.1 1.07 [0.96, 1.21]

2-<4 hours 263 67.2 1.09 [1.03, 1.16] * 30.9 1.05 [0.93, 1.19] 92 22.9 1.18 [1.07, 1.30] *

4-<6 hours 196 63.8 1.06 [0.99, 1.13] 33.7 1.13 [0.98, 1.29] 64 21.3 1.11 [0.99, 1.24]

6+ hours 60 60.8 1.00 [0.89, 1.12] 34.0 1.28 [1.02, 1.62] * 21 23.2 1.17 [0.96, 1.42]

Notes:





5-year excess death rate calculated as = 100% - 5-year relative survival calculated using the period method for ‘at-risk’ cases during 2012-2016 for ages 0-89 years.

SIR and SMR are obtained using Poisson models adjusted for broad age groups and sex.






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Lung cancer


Count Rate SIR [95% CI] 5-year (%)

EHR [95% CI] Count Rate SMR [95% CI]


82.7

1,814 35.1

By remoteness Overall significance1, p<0.001 Overall significance1, p<0.001 Overall significance1, p<0.001

Major city 1,384 44.6 1

80.7 1 980 31.6 1

Inner regional 578 46.6 1.04 [0.99, 1.08] 84.3 1.14 [1.08, 1.20] * 427 34.4 1.08 [1.03, 1.14] *

Outer regional 366 50.3 1.12 [1.06, 1.18] * 85.9 1.28 [1.20, 1.36] * 278 38.6 1.21 [1.14, 1.28] *

Remote/Very remote 65 58.2 1.30 [1.14, 1.50] * 85.1 1.22 [1.07, 1.39] * 46 42.1 1.31 [1.11, 1.54] *


Overall significance1, p<0.001 Overall significance1, p<0.001 Overall significance1, p<0.001


84.9 1

200 24.3 1

Less disadvantaged 420 41.6 1.25 [1.17, 1.34] * 85.4

1.04 [0.95, 1.13] 283 28.2 1.17 [1.08, 1.27] *

Middle 20% 485 43.8 1.32 [1.24, 1.41] * 81.8

1.18 [1.05, 1.34]* 361 32.5 1.35 [1.25, 1.46] *


1.27 [1.17, 1.37]* 418 37.7 1.56 [1.45, 1.68] *


1.29 [1.20, 1.40]* 470 42.9 1.78 [1.65, 1.92]*

By accessibility Overall significance1, p<0.001 Overall significance1, p<0.001 Overall significance1, p<0.001

<1 hour 1805 44.7 1

81.7 1

1,298 32.2 1

1-<2 hours 157 49.9 1.10 [1.02, 1.19] * 86.0 1.23 [1.13, 1.34] * 123 38.7 1.19 [1.10, 1.29] *

2-<4 hours 223 54.1 1.19 [1.11, 1.26] * 84.1 1.13 [1.05, 1.22] * 159 38.1 1.17 [1.08, 1.26] *

4-<6 hours 149 48.5 1.08 [1.00, 1.16] 84.9 1.12 [1.02, 1.23] * 110 36.2 1.11 [1.02, 1.21] *

6+ hours 57 58.3 1.27 [1.13, 1.43] * 85.4 1.18 [1.03, 1.35]* 43 44.6 1.34 [1.17, 1.53] *

Notes:











12

More details about how we classify geographical areas

Remoteness: Remoteness was determined using the Australian Statistical Geography Standard (ASGS) remoteness structure (Volume 5 – Remoteness areas, July 2011) developed by the Australian Bureau of Statistics (ABS), with the “Remote” and “Very Remote” categories combined into one category. http://www.abs.gov.au/websitedbs/D3310114.nsf/home/remoteness+structure#Anchor2b

Area disadvantage: Area disadvantage was categorized by the Socioeconomic Indexes For Areas (SEIFA) The Index of Relative Socio-Economic Disadvantage (IRSD) 2011. SEIFA is developed by the ABS that ranks areas in Australia according to relative socio-economic advantage and disadvantage. The indexes are based on information from the five-yearly Census.

Accessibility: Travel to Cancer Treatment Areas (TRACT) calculated utilising Geographic Information Systems (GIS) technology using MapInfo Professional® and MapMarker® software packages to determine the travel distance to the nearest public and private radiotherapy facility in Queensland in 2011. Statistical Area Level 2 (SA2) regions as defined by the ABS in the 2011 Australian Statistical Geography Standard (ASGS) were used for mapping.

http://www.abs.gov.au/websitedbs/D3310114.nsf/home/remoteness+structure#Anchor2b

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